Bonnie's Blog

Fine Motor Skills in Preschoolers

The development of fine motor skills is an important foundation for future success in school.  In an article published in the American Family Physician, Dr. Hamilton makes two very interesting obsevations about the identification of motor skill deficits in young children.  One, is that a diagnosis of difficulties is often missed because many parents do not recognize it as a serious and modifiable problem.  And second, when parents do present concerns to their physicians, it is common for the physiciams to reassure the parents that their child will outgrow any clumsiness or coordination challenges.  Young children with persistant difficulties with fine motor skills display higher rates of educational, emotional and social problems in adolescence.

Occupational therapy can play an important role in helping young children develop the fine and visual motor skills that they need to meet the demands of school.  Early intervention typically results in a shorter period of therapy and reduces the impact on a child's self esteem.  At Emerge, intervention can begin long before kindergarten if a child is experiencing delays.  Therapy can signficantly improve a child's skills and provide parents with lots of ideas for promoting skill development at home.

By age 2: Scribbles; turns pages 1 at a time; feeds self with spoon and fork

By age 3:  Copies circle and cross; holds pencil with thumb and 1 or 2 fingers; cuts with scissors

By age 4:  Copies a square; cuts out simple shapes; skillful with eating utensils; mature pencil grip

By age 5:  Clear hand preference (often much earlier); draws a variety of recognizable pictures; copies a triangle, writes name, colors within the lines.

If you have a child entering kindergarten who has not mastered the 4 and 5 year old level skills, consider enrolling them in Emerge's Capable Kindergarten summer program. (Call 928-0204).

Supporting speech development with pictures

Photos and pictures provide great support for children as they develop their language skills, both receptive (understanding) and expressive (talking). 

1)  Put pictures of your child, family members, teachers, toys, activities, etc. into a child friendly photo album.  Use the photo album to look through with your child.

2)  Place pictures in magnetic photo holders and place the pictures on the refrigerator for easy access.

3)  Make small books about outings your child has been on, using pictures taken on the outing.  These books provide great support to help your child tell/show others about the outing.

4) Help your child make a placemat using stickers or small pictures of words in their vocabulary.  Cover the mat with clear contact paper.  These were made by 19 month old Jack with stickers representing words he knows.

Holiday Gift Ideas

I have been wanting to share this website Let's Explore for sometime, so when it popped again in a post in my Google Reader, I decided it was time to pass it along.  I love so many of the fine and visual motor materials offered by Let's Explore.  Their wide variety of large stampers and rubbing plates offer successful art experiences, for those children that may be reluctant to engage. 
Have your child use them as a basis for a picture and then add more details with crayons or markers.  They also carry crayon rocks which we frequently use at Emerge to encourage a mature pencil grip.  Other items helpful for developing a mature pencil grip include a wide variety of 'zoo stick (also farm and sea) chopsticks' and paint bellows (good for developing thumb opposition).  If you are not sure, check with your child's therapist to see if any of these items might be helpful for your child.

For language development and pretend play, Let's Explore offers a wide variety of Sticker Play Scenes.  Emerge speech therapists often use these in therapy.  Match the theme to your child's interests.  They are also great to take along when traveling or when a child must entertain themselves for a period of time.                      

Photo Journalism Club

Last week was the first session of Emerge's newest handwriting program.  Handwriting practice can be challenging to make interesting.  So we decided to offer a program that combined taking pictures with writing.  The children participating in this program will using the pictures they take as a basis for developing and writing stories.

The children were divided into teams of two and chose action toys to create a variety of scenes.  They took pictures of these scenes and this week, they will use these photos to develop a story around.  There was much enthusiasm around setting up the scenes.

Other activities included upper body strengthening.  Games to improve fine motor coordination.  Dice story writing (when it is your turn, your roll of the dice determines how many words you will add to the story).

Using Kitchen Activities to Develop Fine Motor Skills

Involving your child in food preparation and other kitchen tasks is a great way to develop their fine motor skills, including grasp, bilateral coordination and tool use.  Additionally working with food is highly motivating for many children.  Check out a recent post at Let's Explore where she outlines a number of simple of kitchen activities (pouring, stirring, cutting, scooping, etc.) geared to preschoolers, although all could certainly be done by older children as well.

Other suggested kitchen activities include:

• Using a potato peeler, often it is easier to start with carrots. A good peeler makes a huge difference.  My favorite is made by Good Grips.
• Spreading with a knife.  Start with spreading on crackers or toast rather than soft bread.
  
• Cutting with a knife and fork.  Cutting pancakes is a good place to start.
• Using scissors to snip fresh herbs.
• Using a rolling pin to roll out cookie dough.
• Kneading bread dough.
• For older children, cracking an egg.
• Using a manual egg beater (can also be used to whip up soap bubbles).
• Folding napkins. 
• Removing strawberry leaves with a strawberry huller.

Why we want babies to crawl

Lately it seems like I hear about one parent a week proudly tell me that her child never crawled and just went straight to walking.  When I hear this, inside I am secretly hoping that their child is fine and doesn't experience any motoric challenges down the road.  In the Occupational Therapy world, it is felt that when an infant crawls on hands and knees they are establishing important foundations for future motor, visual, and learning skills.  Crawling strengthens the trunk, arm, and leg muscles, establishing a foundation for the development of higher level motor skills.

As infants crawl, they visually determine where to go, typically looking back and forth between their hands and their target.  In doing so they develop their near vision, the ability to shift between near and far vision, and further establish eye-hand coordination.  

The weight bearing on open palms is felt to develop the arches of the hand, contribute to separation of the two sides of the hand (skilled and support) and help establish good stability of the thumb joint.  This establishes the foundation for the development of mature pencil grip and ease when writing a few years down the road.  We are seeing record numbers of children who are struggling to hold a pencil correctly, because they lack the motor foundations to do so.

Infants from birth on need to spend part of their day on their stomachs.  Gradually they will develop the neck, back, shoulder muscles to bring their upper bodies off the surface and eventually move into crawling.  Infants who spend most of their time either on their backs or propped in sitting often miss out on this important milestone, as they have missed the months of tummy time preparation that allows them to move smoothly into crawling.

What is Therapeutic Listening (and can it help my child)?

Therapeutic Listening®  combines a sound-based intervention with a sensory diet to impact a child's sensory processing and behavioral organization. Therapeutic Listening can impact sensory modulation, attention, behavior, postural organization, and speech and language difficulties. Therapeutic Listening employs electronically altered compact discs that are used in a home program, providing parents the opportunity to significantly enhance their child's sensory program on a daily basis  Ceck out the  Vital Links website for more detailed information, including a four page parent handout.

At Emerge, we have found that therapy outcomes are improved and the length of time in therapy is often reduced when the child is on a consistant Therapeutic Listening program.  Therapeutic Listening is started during therapy sessions and then if it seems to be a good match for the child, headphones and CD can be loaned for a two week trial.  After that, parents puchase the headphones and join the Emerge Therapeutic Listening library so that they can take advantage of a wide array of CDs.  Each CD provides a somewhat different impact on the nervous system, depending on the style of music and instrumentation.

Case one:  A seven year old boy who had been receiving occupational therapy for four months prior to starting Therapeutic Listening.  Each week his teacher sent home a checklist of negative behaviors this child demonstrated during the school week.  Typically it included 16-18 negative checks.  After one week of therapeutic listening (and without informing the teacher), this child brought home a report with only 3 negative checks.

Case two:  A four year old boy who had severe auditory defensiveness, to the point where he would vomit when a fire drill occured at school.  Additionally he would become so overwhelmed at school, that he would growl at other children and attempt to bite them.  After a few weeks of Therapeutic Listening, he was able to just cover his ears in response to the fire drill and was able to appropriately interact with his classmates.

Summer Travel when your child has a Sensory Processing Disorder, part 2

In the last post, we explored strategies to support your child on vacation if he or she is a sensory seeker, but what if your child is more of a sensory avoider.  Some children have sensitive nervous systems that are easily overwhelmed.  Depending on the child, they may demonstrate sensory defensiveness and/or poor sensory regulation/modulation.  As a result, careful planning is needed to make a vacation successful.

1.  Establish familiar routines. Children with sensory defensiveness benefit from predictability and familiarity.  Establish a routine to the days.  In thinking about the day's activities, less is typically better for this child.  If you are using sensory supports (deep pressure protocol, sensory diet, therapeutic listening, etc,) continue these and ask your child's occupational therapist if any adjustments should be made to the program you are currently implementing.  Pack favorite clothes, soap, shampoo, toothpaste.  Remember sunglasses and hat if your child is sensitive to the sun.

2.  Don't push interactions with relatives.  For many children, visiting is overwhelming people they don't know very well:  people wanting to hug and kiss them or even pick them up; people that may be loud; houses that may smell funny; food that is different from what they are used to, etc.  Let your relatives know what works for you child: let them initiate any physical interaction; establish a safe, quiet place if they need it; bring familiar items to make sleeping (pillow, blanket), play, and eating comfortable.

3.  Plan for down times.  Remember that even when your child is having a good time, it can still be draining on their nervous systems and require some quiet time to recoup.   If touring a busy city, find a quiet place to eat, go back to the hotel room or play in a park for awhile.  Giving a sensitive child time to regroup can help them manage themselves better and reduce/prevent meltdowns. Years ago when I took my seven year old son to Disney World, we went to the park when it opened and stayed until lunch time.  Then we went back to the hotel and pool for the afternoon, returning to the park in late afternoon, making for a much more relaxing experience.

4.  Honor your child's perceptions.  While it can be frustrating to parents, when children react negatively to experiences that are generally perceived as being fun, it is important to recognize that their reacts are based on how their nervous system perceives the experience.  Listen to them and modify your plans.  While it is fine to expose your child to new experiences and gently encourage their participation, be careful not to force your child to engage in an activity that for them is at best uncomfortable and at worse triggers a fight/flight/fright/freeze response.  For some children, the beach is overwhelming:  the sand; splashing, cold, salty water; hot sun; lots of people.  For some children, movement is frightening: going on rides, esp. roller coasters is the last thing they want to do.

Vacationing with your child who has a sensory processing disorder can be challenging, but with careful planning and a little accommodation, the vacation can be a wonderful experience for the entire family.

Summer Travel when your child has a Sensory Processing Disorder, part 1

Often taking children out of their home and familiar routines can often be challenging.  When you plan your summer vacation, think about your child's sensory needs and how they respond to different environments.  Every child's needs are different and we often tell parents they need to be detectives to discover what works best for their child.

The sensory seeker:  Chances are this child will love vacation, especially if their are lots of opportunities for physical activity.  We see many children who thrive at the beach.  Walking/running on the beach, digging in the sand, playing in the water, being knocked over by waves, etc. often provides an intensive sensory diet that is hard to match back at home.  These same children also often love amusement parks, especially if they seek vestibular input: the various rides, including roller coasters, again provide intensive sensory input opportunities. 

The challenge is to provide transition activities at the end of the day to help your child make a smooth transition from a stimulating environment back to the hotel, cottage or grandma's house.  Move to activities that are somewhat less stimulating at the end of the day; building a sand castle, riding a train or other less stimulating ride.  Have your child wear a backpack with 5 - 10% of his or her body weight on the walk back to the car.  Provide a snack at the car including something crunchy or chewy and a drink with a straw.  If your child is doing a Theraputic Listening program, this may be a good time to use it.  Ask your therapist for a suggestion about a good CD for this transition.  Provide a fidget (e.g. squeeze ball, theraputty, etc.) for the ride.

The more challenging situations for the Sensory Seeker are when they need to be still:  airplane rides, long car rides, etc.  Be sure to 'pre-load' your child's nervous system by engaging them in physical activity before asking them to sit still.  If traveling by car, stop every 1-2 hours at a roadside park for a movement break.  Have a ball, frisbee, theraband, etc. ready to facilitate active play.  When they need to sit, provide activities for their hands (think heavy work: play dough/clay, pop beads, hole puncher) and something for their mouths (gum, star bursts, fruit leather, bagels, jerky, water bottle with straw).

And even though children who are Sensory Seekers tend to like a lot of activity, all children can become overloaded.  Don't pack every day with activities, especially if you are seeing lots of relatives or are spending the week at Walt Disney (or similar).  Build in some times that are less stimulating, allowing your child time to regroup.

 

Art Supplies

I wanted to share the Stubby Pencil Studio, a great on-line resource for eco friendly drawing and art supplies.  They carry Crayon Rocks which we use in the office and have often recommended to parents for home use.  The unique shape of the crayons promotes a mature pencil grasp.  They have a variety of triangular shaped pencils which also help promote a mature pencil grip, including Jumbo Triangular Color EcoPencils, which at just 5" long, fit well into small hands.  I also like their Color 'n Kids cards that offer a simple design with a word to trace.  A great way to encourage your child to make their own thank-you or other greeting cards.